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Addressing Health Disparities
Research Directions Outlined at NIAMS Conference

By Connie Raab

Arthritis and musculoskeletal and skin conditions are among the most frequent chronic health problems in the United States, but not all population groups are equally affected. There are marked differences in the prevalence, morbidity and disability associated with specific diseases in African American, Hispanic, Native American and Caucasian populations.

Recognizing these disparities, NIAMS recently convened experts in many disciplines from around the country for a health disparities conference. The goals were threefold: to highlight current knowledge about genetic, environmental, social and behavioral factors that play a role in health disparities; to identify intervention strategies that could provide models to reduce disparities; and to define challenges and emerging opportunities for research.

Attendees at the NIAMS conference included (from l) Dr. David Satcher, assistant secretary for health and surgeon general; Reva Lawrence, conference organizer; Dr. Ruth Kirschstein, NIH acting director; and Dr. Stephen Katz, NIAMS director.

In his opening remarks, Dr. David Satcher, assistant secretary for health and surgeon general, commented that he had not been to a conference that dealt so well with both major goals of Healthy People 2010 (DHHS' national health blueprint): to increase quality and years of life and to eliminate health disparities. He said that NIAMS topics were some of the best examples of challenges to one's quality of life, in that millions suffer from arthritis, back pain, osteoporosis, skin diseases and other disorders within the institute's mandate.

Dr. Susan Taylor, director of the Skin of Color Center at St. Luke's-Roosevelt Hospital Center in New York City, speaks about the differences in skin and hair structure between ethnic groups.

Conference speakers raised a number of issues, including the following:

• Race and ethnicity are not defined consistently and are sometimes used interchangeably, when they are two different constructs. Given the strong association between some "racial" groups and socioeconomic status (SES), the contribution of race and SES to disease outcome is difficult to sort out. However, the use of SES as a variable may be justified in research if we are to eliminate health disparities and improve the overall health of the population.

• There is a need for basic descriptive data on the structure and function of hair and skin in people of color, along with studies of the epidemiology, clinical presentation, natural history, complications and other aspects of common skin diseases. Valid measurement tools for diseases in skin of all hues are needed as well.

• Studies have found that osteoarthritis (OA) of the hip and knee occurs more often in African American men than in Caucasian men. Systemic lupus erythematosus (SLE), another autoimmune disease, occurs more often and more severely in African Americans and Hispanics than in Caucasians. Keloids (an overgrowth of scar tissue after a skin injury) and vitiligo (formation of white patches on the skin) occur more often in African Americans.

• Some populations experience disparities in treatments received; the reasons for this should be studied. For example, although acne vulgaris is a common skin condition in African Americans and isotretinoin is considered an effective therapy, the drug is prescribed less often for African American acne patients than for others. African Americans are less likely than Caucasians to undergo total joint replacement surgery, and they also receive less intense diagnostic and treatment courses for low back pain when compared with Caucasians.

• Researchers are studying gene expression and biomarkers in scleroderma, SLE and OA. They are also studying modifiable behaviors and environmental exposures to determine their links to disease. It was suggested that researchers collect data of a broad nature from behavioral, psychosocial, clinical and genetic studies.

Dr. Graciela Alarcón discusses race and ethnicity.

Some broad questions posed by the conference included: What research initiatives would have the widest impact across the range of diseases and conditions where disparities exist? Where should the research focus be: Genetic pathways? Behavioral interventions? Gene/environment interactions? What are barriers to getting this research done?

Conference cosponsors included several components of NIH: the National Center on Minority Health and Health Disparities, the Office of Research on Women's Health, the Office of Disease Prevention and the Office of Behavioral and Social Sciences Research. Other cosponsors were the Centers for Disease Control and Prevention, Arthritis Foundation, American College of Rheumatology, American Academy of Orthopaedic Surgeons and American Academy of Dermatology.

Jose Cordero, an NIH Academy trainee from the University of Tampa, Florida, who is now with NIAMS, questions a speaker.

Tarice Barnes asks a question at NIAMS's health disparities conference.